Perioperative desaturation and risk factors in general anesthesia.

OBJECTIVE: Despite advances in anesthetic technique, the incidence of perioperative desaturation in general anesthesia has remained high. Knowledge on factors associated with intraoperative desaturation is relatively scanty. The purpose of the present study was to investigate the distribution of time dependent intraoperative desaturation and factors predicting perioperative desaturation. MATERIAL AND METHOD: A prospective observational analytic study was conducted. One thousand and ninety three patients schedule for elective surgery under general anesthesia (GA) were enrolled. Exclusion criteria were patients with preoperative arterial oxygen saturation (SpO2) < or = 95%, pregnant women, obvious difficult airway and those requiring mechanical ventilation postoperatively. Desaturation was defined as oxygen saturation < or = 95% for > or = 10 seconds. RESULTS: Among 1093 eligible cases, 30 cases (2.74%) developed intraoperative desaturation. The probability of desaturation during induction, maintenance, and emergence were 0.55% (6/1093), 2.01% (22/1093), and 0.18% (2/1093), respectively. Occurrences of desaturation at the recovery room (RR) were noted in 224 patients (20.49%). Younger, obese patients, snorers, and lower respiratory tract infection were significant high-risk groups of intraoperative desaturation. Elderly, obese patients, snorers, positive history of pulmonary disease, modified Aldrete's score < or = 8, and duration of GA > or = 180 minutes predicted desaturation at RR. CONCLUSION: Obesity and snorers were the high-risk groups of perioperative desaturation. Elderly patients are at lower risk of desaturation than children intraoperatively, but at a higher risk in the postoperative period Higher FiO2 should be given to high-risk patients during the intraoperative period. Desaturation can still occur at RR, even in patients who received oxygen. Pulse oximeter monitoring should be continued throughout RR care.

Awake intubation with Airtraq laryngoscope in a morbidly obese patient.

The Airtraq laryngoscope (AL) is a new disposable tracheal intubation device. The authors reported the case of a successful awake intubation with AL of the trachea in a morbidly obese patient. A 54-year-old female, morbidly obese (BMI 38 kg/m), patient was scheduled for a tumor removal of the right eye under general anesthesia. She had symptoms of gastroesophageal reflux. The preoperative airway assessment showed difficult ventilation and intubation. An awake intubation under sedation and topical airway anesthesia were chosen. The first attempt of tracheal intubation with AL was unsuccessful because the tip of endotracheal tube (ET-tube) pointed to the arytenoid cartilage. The second attempt, with slight rotation of AL, glottic view showed grade I and the ET-tube passed through the vocal cords easily The authors 'experiences demonstrated that the AL could be used while awake and may be an alternative laryngoscope for airway management in morbidly obese patients.

Attitudes, beliefs, and expectations of gynecological patients toward postoperative pain and its managementt.

OBJECTIVE: To examine the attitudes, beliefs, and expectations of gynecological patients regarding postoperative pain and management. MATERIAL AND METHOD: A prospective study performed in 112 patients undergoing major gynecological surgery, using a preoperative questionnaire regarding expectations toward postoperative pain and management and a postoperative questionnaire regarding actual pain experience, attitudes, and beliefs about pain and management. RESULTS: The majority expected (92%) and experienced (89%) postoperative pain at moderate to very severe levels. The median visual analog scales (VAS) of expected and maximum experienced pain were 6.4 and 6 6, respectively. Ninety-eight percent reported at least moderate pain relief from the analgesics administered. Ninety-two percent were satisfied with their pain management. A significant number held misconceptions about postoperative pain and its management. CONCLUSION: Patients should be preoperatively advised regarding postoperative pain and management. Misunderstandings should be corrected to improve the quality and adequacy of postoperative pain management.

Lightwand-assisted nasotracheal intubation in awake ankylosing spondylitis.

Several techniques of airway management in ankylosing spondylitis (AS) have been reported. No study related specifically to the use of a lightwand-assisted intubation in AS has been previously described. The present case report demonstrates that an awake, nasotracheal intubation can be successfully performed to provide general anesthesia in a patient with AS. A 65-year-old Thai male was scheduled for exploratory surgery under general anesthesia. Past medical history consisted of hypertension and AS. The preoperative airway assessment showed limitation of mouth opening, an extremely anteriorly flexed and immobile cervical spine. An awake intubation under sedation and topical airway anesthesia were chosen. Multiple attempts at blind nasotracheal intubation and oral approach with lightwand were unsuccessful. Finally, intubation was successfully performed with lightwand by nasal route. This serves to show that an awake nasotracheal intubation with a lightwand may be a safe and useful alternative option for airway management in patients with severe ankylosing spondylitis.